The use of surgery in displaced scapular neck fractures.

OBJECTIVES: To evaluate the use of surgical management in displaced scapular neck fractures. SUBJECTS AND METHODS: 14 adult male patients (average age 34 years, range 19-44) with displaced scapular neck fractures were treated by open reduction and internal fixation in Al-Jahra Hospital, Kuwait from April 2000 to January 2004. Patients' clinical and radiological results were analyzed retrospectively. RESULTS: The average follow-up was 20 months (range 6-30 months). Anatomical or near-anatomical reduction of the fracture with excellent clinical function was obtained in 12 patients (86%) and with good functional outcome in 2 patients (14%). One patient with associated head injury developed heterotopic ossification connected to the lateral border of the scapula. CONCLUSION: The results of this report show that open reduction and internal fixation of grossly displaced scapular neck fractures are the treatment of choice for these injuries to restore the normal biomechanics of both glenohumeral and scapulothoracic joints and allow favorable clinical outcome.

Surgical treatment for ipsilateral fractures of femoral neck and shaft.

OBJECTIVES: To review the primary and the final results of surgical management of ipsilateral femoral neck and shaft fractures. SUBJECTS AND METHODS: Seventeen patients (2 female, 15 male, average age 37 years, range 20-60) with ipsilateral femoral neck and shaft fractures were treated by compression plate fixation for the femoral shaft fractures and dynamic hip screw or cannulated cancellous screw fixation for the neck fractures in Al-Razi and Al-Jahra Hospitals, Kuwait, from March 1996 to June 2002. The clinical and radiological primary and final results were analyzed retrospectively. RESULTS: The average follow-up for the primary outcomes was 3.6 years (range 2-6 years). 100% union of the femoral neck fractures, 0% osteonecrosis of the femoral head and 77% union of the shaft fractures were achieved. Complications of femoral shaft fractures, nonunion and metal failure, occurred in 4 (23%) patients and postsurgical infection occurred in 1 patient. At the final follow-up, 15 (88%) patients achieved good clinical outcome and 2 (12%) had fair outcome. CONCLUSION: Our results show that compression plate fixation for the femoral shaft fracture and dynamic hip screw or cannulated screw fixation for the neck fracture in combination injury is a reliable and adequate technique.

Kirschner wires caused unexpected complications of femoral neck fracture.

OBJECTIVE: To report a unique complication of the surgical treatment of femoral neck fractures. CLINICAL PRESENTATION AND INTERVENTION: A young adult presented with lower abdominal pain and bleeding per rectum caused by rectal transfixion by Kirschner wires (K wires). The wires were used to fix a fracture on the neck of the femur during the Iraqi occupation of Kuwait. A plain X-ray showed an old united fracture of the neck of the left femur with coxa magna, mild coxa vara and mild secondary osteoarthritis of the left hip joint. Limited barium enema disclosed transfixion of the rectum by two radiopaque K wires in the pelvis with rectal track formation around them. The complication necessitated a laparotomy and a major dissection to remove the K wires. CONCLUSION: The K wire provided an immediate solution during a difficult period. However, since it is not normally used for this purpose, it caused subsequent complications that were resolved by laparotomy and a major dissection.